Aims. Intra-articular (IA) injection may be used when treating hip osteoarthritis (OA). Common injections include steroids, hyaluronic acid (HA), local anaesthetic, and platelet-rich plasma (PRP). Network meta-analysis allows for comparisons between two or more treatment groups and uses direct and indirect comparisons between interventions. This network meta-analysis aims to compare the efficacy of various IA injections used in the management of hip OA with a follow-up of up to six months. Methods. This systematic review and network meta-analysis used a Bayesian random-effects model to evaluate the direct and indirect comparisons among all treatment options. PubMed, Web of Science, Clinicaltrial.gov, EMBASE, MEDLINE, and the Cochrane Library were searched from inception to February 2023. Randomized controlled trials (RCTs) which evaluate the efficacy of HA, PRP, local anaesthetic, steroid, steroid+anaesthetic, HA+PRP, and physiological saline injection as a placebo, for patients with hip OA were included. Results. In this meta-analysis of 16 RCTs with a total of 1,735 participants, steroid injection was found to be significantly more effective than placebo injection on reported pain at three months, but no significant difference was observed at six months. Furthermore, steroid injection was considerably more effective than placebo injection for functional outcomes at three months, while the combination of HA+PRP injection was substantially more effective at six months. Conclusion. Evidence suggests that steroid injection is more effective than saline injection for the treatment of hip joint pain, and restoration of functional outcomes. Cite this article: Bone Joint J 2024;106-B(6):532–539

Wearable inertial sensors can detect abnormal gait associated with knee or hip osteoarthritis (OA). However, few studies have compared sensor-derived gait parameters between patients with hip and knee OA or evaluated the efficacy of sensors suitable for remote monitoring in distinguishing between the two. Hence, our study seeks to examine the differences in accelerations captured by low-frequency wearable sensors in patients with knee and hip OA and classify their gait patterns. We included patients with unilateral hip and knee OA. Gait analysis was conducted using an accelerometer ipsilateral with the affected joint on the lateral distal thighs. Statistical parametric mapping (SPM) was used to compare acceleration signals. The k-Nearest Neighbor (k-NN) algorithm was trained on 80% of the signals' Fourier coefficients and validated on the remaining 20% using 10-fold cross-validation to classify the gait patterns into hip and knee OA. We included 42 hip OA patients (19 females, age 70 [63–78], BMI of 28.3 [24.8–30.9]) and 59 knee OA patients (31 females, age 68 [62–74], BMI of 29.7 [26.3–32.6]). The SPM results indicated that one cluster (12–20%) along the vertical axis had accelerations exceeding the critical threshold of 2.956 (p=0.024). For the anteroposterior axis, three clusters were observed exceeding the threshold of 3.031 at 5–19% (p = 0.0001), 39–54% (p=0.00005), and 88–96% (p = 0.01). Regarding the mediolateral axis, four clusters were identified exceeding the threshold of 2.875 at 0–9% (p = 0.02), 14–20% (p=0.04), 28–68% (p < 0.00001), and 84–100% (p = 0.004). The k-NN model achieved an AUC of 0.79, an accuracy of 80%, and a precision of 85%. In conclusion, the Fourier coefficients of the signals recorded by wearable sensors can effectively discriminate the gait patterns of knee and hip OA. In addition, the most remarkable differences in the time domain were observed along the mediolateral axis

There are a number of patients in whom hip preservation surgery is not indicated as they have developed signs of early osteoarthritis, and nor can they have a hip replacement as they are too early in the disease process. The use of PRP in OA of the hip has not been studied systematically and this study concisely collates all the available data in the use of PRP in Hip OA. This systematic review and meta-analysis aimed to assess intra-articular platelet-rich plasma as a therapeutic intervention for hip osteoarthritis, including the duration of efficacy, influence of dose and composition of PRP, and the incidence of adverse effects. We performed literature searches on the MEDLINE, EMBASE, CINHAL, WEB OF SCIENCE, COCHRANE and SCOPUS databases, and PRSIMA guidelines were followed. Data was pooled using random effects meta-analysis. We assessed quality of the included studies using the Methodological Index for Non-Randomised Studies (MINORS) instrument, with an additional assessment for Randomised Controlled Trials with the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Eight studies were included in the analysis, with data from a total of 331 patients. PRP significantly reduced pain compared to baseline at multiple timepoints, with the greatest effect at 1–2mo follow-up. PRP only significantly improved function at the 1–2mo follow-up. A significantly larger reduction in pain was achieved with a single injection or PRP compared to multiple injections, a total injected dose of PRP <15mL compared to ≥15mL or using a leukocyte-poor PRP preparation compared to leukocyte-rich PRP. There were no lasting adverse effects. Low and moderate quality evidence suggests that PRP reduces pain and improves function at endpoint compared to baseline. Moderate quality evidence suggests a larger reduction in pain is achieved with a single injection of PRP compared to multiple injections, and low quality evidence attributes a larger reduction of pain with a total injected dose of PRP <15mL compared to ≥15mL or using leukocyte-poor PRP compared to leukocyte-rich PRP

Introduction: Femoroacetabular impingement (FAI) is one of the main causes of hip osteoarthritis. Femoral retroversion has been reported as a cause of FAI and it is well established that a retroverted femur produces hip pain and alterations in the external and internal rotation balance. However, no studies of femoral retroversion in patients with FAI have been reported. Furthermore, since the lack of internal rotation is a common feature in patients with FAI, it could be possible that femoral version abnormalities are present in these patients. The purpose of this study is to describe the femoral version in a group of patients with FAI and to assess its relation in the development of hip osteoarthritis. Methods: The history, x-rays and hip CT scans of 142 patients with FAI were reviewed. All patients presented persistent hip pain and were evaluated clinically between January 2006 and July 2008. We defined FAI when at least one of the following features were present:. an abnormal alpha angle (> 49°) measured on the elongated femoral neck x-ray,. a positive cross-over sign or pro-trusio acetabuli in the AP pelvis x-ray,. the presence of diminished anteversion in the femur (< 10°) or a retroverted femur (< 0°) in the CT scan, associated with a positive hip impingement test and lack of internal rotation at 90 degrees of flexion. We documented the type of FAI, the presence of acetabular dysplasia, coxa valga, coxa vara and the femoral version measured on the CT scan. The degree of osteoarthritis of the hip using the Tönnis classification was documented as well. Results: Two hundred and sixty-five FAI hips from 142 patients (73 females and 69 males) were analyzed. The average age was 36.7 years. The mean femoral version was 11.4 ° (−14.1° to 47°). We found 43 hips (16.6%) of the femora were retroverted and 133 hips (50%) had either diminished anteversion (< 10°) or were retroverted. In 12 hips (0.05%) the only cause of FAI was the presence of a diminished anteversion or retroverted femur. The statistical analysis using the generalized estimating equations method including the right and left hips, shown that among these six predictors, both femoral retroversion (p=0.046) and coxa vara (p< 0.001) were statistically significant for the presence of osteoarthritis. Conclusion: The presence of a retroverted femur seems to be a cofactor in the development of hip osteoarthritis in patients with FAI. The orthopedic surgeons should be aware of the high frequency of femoral retroversion when evaluating patients with hip impingement, in order to make the right diagnosis and treatment. It might be possible that this association between FAI and femoral retroversion is due to a common hip disease during skeletal maturation (i.e. SCFE) leading to two anatomical alterations at the proximal femur: reduced head-neck offset and retroverted femur

Summary. The dGEMRIC index correlates more strongly with the pattern of radiographic joint space narrowing in hip osteoarthritis at five year follow-up than morphological measurements of the proximal femur. It therefore offers potential to refine predictive models of hip osteoarthritis progression. Introduction. Longitudinal general population studies have shown that femoroacetabular impingement increases the risk of developing hip osteoarthritis, however, morphological parameters have a low positive predictive value. Arthroscopic debridement of impingement lesions has been proposed as a potential strategy for the prevention of osteoarthritis, however, the development of such strategies requires the identification of individuals at high risk of disease progression. We investigated whether delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC) predicts disease progression. This imaging modality is an indirect measure of cartilage glycosaminoglycan content. Patients and Methods. 34 asymptomatic individuals from a longitudinal cohort study (sibkids) were assessed at baseline with the collection of Patient Reported Outcome Measures (PROMs), anteroposterior and cross-table lateral radiographs, 3D morphological MRI, and dGEMRIC at 3T of their index hip. A dGEMRIC index was calculated as a ratio of the anterosuperior acetabular cartilage T1 relaxation time and the total femoral and acetabular cartilage T1 relaxation time. 29 individuals were followed up at 5 years for repeat assessment (average age 51 years and range 36 to 67). Radiological measurements were made by a single observer using in house Hipmorf software. Radiographic disease progression was assessed using minimum joint space width (JSW), lateral sourcil JSW, and medial sourcil JSW. These were measured on baseline and five year follow-up anteroposterior radiographs with an intra-observer ICC of 0.916. Alpha angle measurements were made by the same observer on radiographs and MRI radial slices with an intra-observer ICC of 0.926. Results. Mean minimum JSW for the cohort fell by 0.16mm over five years (p=0.024). Baseline dGEMRIC index did not correlate with change in minimum JSW (r=0.031 p=0.873). There was a moderate correlation between baseline dGEMRIC and the direction of JSW loss (change in JSW at the lateral sourcil minus change in JSW at the medial sourcil) (r=0.561 p=0.002). There was a weak correlation between the change in Non-Arthritic Hip Score and baseline dGEMRIC (r=0.256 P=0.180). Maximum alpha angle measured on baseline MRI radial slices did not correlate with change in minimum JSW and weakly correlated with the direction of JSW narrowing (r=0.273 p=0.160). Conclusion. A low dGEMRIC index indicates reduced glycosaminoglycan concentration in the anterosuperior acetabular cartilage compared with the total femoral and acetabular cartilage. This correlates with lateral JSW narrowing relative to medial JSW narrowing as osteoarthritis progresses. The dGEMRIC index correlates better with osteoarthritis progression than alpha angle measurements and offers the potential to refine a predictive model for osteoarthritis progression to aid patient selection for clinical trials

Introduction and Objective. Hip osteoarthritis (OA) is the leading cause for total hip arthroplasty (THA). Although, being considered as the surgery of the century up to 23% of the patients report long-term pain and deficits in physical function and muscle strength may persist after THA. Progressive resistance training (PRT) appear to improve several outcomes moderately in patients with hip OA. Current treatment selection is based on low-level evidence as no randomised controlled trials have compared THA to non-surgical treatment. The primary objective of this trial is to determine the effectiveness of THA followed by standard care compared to 12 weeks of supervised PRT followed by 12 weeks of optional unsupervised PRT, on changes in hip pain and function, in patients with severe hip OA after 6 months. Materials and Methods. This is a protocol for a multicentre, parallel-group, assessor blinded, randomised controlled superiority trial. Patients aged ≥50 years with clinical and radiographic hip OA found eligible for THA by an orthopaedic surgeon will be randomised to THA or PRT (allocation 1:1). The primary outcome will be change in patient-reported hip pain and function, measured using the Oxford Hip Score. Key secondary outcomes will be change in the Hip disability and Osteoarthritis Outcome Score subscales, University of California Los Angeles Activity Score, 40-meter fast-paced walk test, 30-second chair stand test, and number of serious adverse events. Results. The trial has been approved by The Regional Committees on Health Research Ethics for Southern Denmark (Project-ID: S-20180158) in February 2019 and registration was performed at . ClinicalTrials.gov. (NCT04070027) in August 2019. Recruitment was initiated on the 2. nd. of September 2019 and the final deadline will be on the 30. th. of June 2021, or when a sample size of 120 patients has been accomplished. Conclusions. The results of the current trial are expected to enable evidence-based recommendations, which may be used to facilitate the shared-decision making process in the discussion of treatment strategy for the individual patient with severe hip OA. All results will be presented in peer-reviewed scientific journals and international conferences

The aim of this paper is to compare the effectiveness on the amelioration of symptoms of hip osteoarthritis (OA) between Nimesulide and intraarticular injection of Hyaluronic acid (HA). In the Orthopaedic outpatient department of our Hospital we selected 22 patients suffering from hip osteoarthritis as it is defined by the American College of Rheumatology after clinical, radiological and blood examinations. The age range was 62 – 82 years and were all female. They were seperated into two groups. Group A included 13 patients treated with Nimesulide (NSAID) for a period of 20 days and Group 2 included 10 patients treated with five intraarticular injections of HA in the hip joint, one every week, under ultrasound control. Before treatment initiation we performed clinical examination for active and passive flexion, internal and external rotation of the hip. Pain evaluation was with VAS and Lequense algofunctional index. We repeated the examination and evaluation a month, six months and a year after the end of the treatment. Following the Helsinki proclamation we did not use placebo group. The results in group A has shown that 8 patients had considerable amelioration of their symptoms, 3 has a mild amelioration and 2 patients none. In group B considerable amelioration was observed in all 10 patients. We have noticed that although therapeutic result is usually expected at the end of the treatment, 6 of the patients had improvement after the first 2 intraarticular injections, especially for night pain, and the others just before the end of the treatment. The duration of the improvement for group A was 15 days in one patient, 30 days in seven and 3 months in three patients. In group B the duration of improvement was 20 days in one patient, 2 months in two, 6 months in five and 11 months in two patients. In patients of group B symptoms’ recurrence was not so intense as in the first time. In group A symptoms’ recurrence was at the same level as before treatment initiation. No complication was observed from the intraarticular injections. In conclusion we could say that treatment with HA is more effective concerning the duration of the symptoms amelioration. There is no risk from gastrointestinal complications

This observational study was undertaken to explore the relationship of the foot posture of patients with Medial Compartment Osteoarthritis of the knee (MCOA), patients with hip osteoarthritis (OA) and a healthy control group, using the Foot Posture Index (FPI). Goniometric measurement of talocrural dorsiflexion was also included. The relationship of foot posture to MCOA and hip osteoarthritis OA has not been explored although in other medical fields, such as neurology and sports medicine, the relationship between foot posture, lower limb pain and function has been acknowledged. In view of the current high incidence of lower limb OA, any investigation of associations that may lead to improved assessment and conservative management is worthy of consideration. Currently, systematic examination of the foot is not undertaken in routine clinical assessment of patients with lower limb OA and, if this were to be introduced, there would be difficulty in selecting suitable clinical outcome measures. The recent development of the Foot Posture Index (FPI) has addressed the need for a diagnostic clinical tool that measures foot posture in multiple planes and anatomical segments. Sixty participants took part: twenty patients with radiographic and clinical evidence of MCOA grade IV, twenty patients with radiographic and clinical evidence of stage IV OA hip, and twenty age-matched healthy volunteers as a control group. A one way Analysis of variance (ANOVA) was performed to investigate any differences between the 3 groups for foot posture using FPI scores and talocrural dorsiflexion measurements. This showed that there were significant differences between the groups (p< 0.001). Patients with MCOA had a high positive FPI score (indicating a pronated foot), patients with hip OA had a low negative FPI score (indicating a supinated foot). The healthy controls had a normal score distributed over a wider range than the other two groups. In addition, the results of the Pearsons test indicate that the FPI correlated positively with talocrural dorsiflexion (r = 0.55, p< .001). Differences in foot characteristics may be influenced by specific treatment modalities such as gait reducation, orthotic provision, specific lower limb strengthening and stretching exercises. Foot assessment might therefore be a useful adjunct to conservative management of both MCOA and hip osteoarthritis

Objectives. There are few reports on total hip arthroplasty (THA) for hip osteoarthritis associated with so-called Perthes-like change including high great trochanter, short neck hip or flattened femoral head (hereinafter called “Perthes-like change”) as the operative procedures are difficult. We studied THA for “Perthes-like change” carried out in our department. Methods. We covered 14 cases (15 hips), which underwent THA for “Perthes-like change” (hereinafter called “Perthes-like change group,” operated from 2008 to September 2011. The average age at the operation was 62 (53 to 83 years old), 7 males and 7 females, and the average follow-up period was 21.8 months (6 to 48 months). For these cases we studied the clinical items and further made a comparative review of the 258 hips as a control group (Group C), which underwent THA during the same period for osteoarthritis (OA) originating in DDH (developmental dysplasia of the hip) (Crowe type 1 and 2), excluding the “Perthes-like change group.” The items reviewed include the age at the operation, operation time and intraoperative blood loss. Results. The average JOA score of the “Perthes-like change group” at the time of the study was 89 and favorable. The average operation time of the “Perthes-like change group” was 113 minutes (69 to 202 minutes) and its average intraoperative blood loss was 1066 g (490 to 3314 g). The operation time of the “Perthes-like change group” was significantly longer compared to that of the Group C (p=0.004), and its intraoperative blood loss was also significantly larger than that of the Group C (p=0.018). We carried out the muscle release operation for 8 hips (53.3%) of the “Perthes-like change group” and we combined the retachment of the great trochanter for the 1 case of them. There was no dislocation, infection, neuroparalysis and pulmonary embolism. Consideration. The “Perthes-like change group” had a longer operation time and a larger intraoperative blood loss than those of the Group C. Also there were quite a few cases that needed muscle release operation. Therefore, care should be taken in THA for hip osteoarthritis associated with “Perthes-like change” although the clinical results were favorable

Introduction. Hip osteoarthritis (OA) results in reduced hip range of motion and contracture, affecting sitting and standing posture. Spinal pathology such as fusion or deformity may alter the ability to compensate for reduced joint mobility in sitting and standing postures. The effects of postural spinal alignment change between sitting and standing is not well understood. Methods. A retrospective radiographic review was performed at a single academic institution of patients with sitting and standing full-body radiographs between 2012 and 2017. Patients were excluded if they had transitional lumbosacral anatomy, prior spinal fusion or hip prosthesis. Hip OA severity was graded by the Kellgren-Lawrence grades and divided into two groups: low-grade OA (LOA; grade 0–2) and severe OA (SOA; grade 3–4). Spinopelvic parameters (Pelvic Incidence (PI), Pelvic Tilt (PT), Lumbar Lordosis (LL), and PI-LL), Thoracic Kyphosis (TK; T4-T12), Global spinal alignment (SVA and T1-Pelvic Angle; TPA; T10-L2) as well as proximal femoral shaft angle (PFSA: as measured from the vertical), and hip flexion (difference between change in PT and change in PFSA) were also measured. Changes in sit-stand radiographic parameters were compared between the LOA and SOA groups with unpaired t-test. Results. 548 patients were identified with sit-stand radiographs, of which there were 311 patients with LOA & 237 with SOA. After propensity score matching for Age, BMI, and PI, 183 LOA & 183 SOA patients were analyzed. Standing alignment analysis demonstrated that SOA patients had greater SVA (31.1 ± 36.68 vs 21.7 ± 38.83, p=0.02), and lower TK (−36.21 ± 11.98 vs −41.09 ± 11.47, p<0.001). SOA patients had lower PT, greater PI-LL, lower LL, lower T10-L2, and lower TPA (p>0.05). PFSA (9.09 5.19 vs 7.41 4.48, p<0.001) was significantly different compared to LOA while SOA KA was not significantly different compared to LOA. Sitting alignment analysis demonstrated that SOA patients had higher PT (29.69 ± 15.65 vs 23.32 ± 12.12, p<0.001), higher PI-LL (21.64 ±17.86 vs 12.44 ±14.84 p<0.001), lower LL (31.67 ± 16.40 vs 41.58 ± 14.73, p<0.001), lower TK (−33.22 ± 15.76 vs −38.57 ± 13.01, p=0.01), greater TPA (27.91 ± 14.7 vs 22.55 ± 11.38 p=0.01). TK, SVA, and PFSA were not significantly different compared to LOA. SOA and LOA groups demonstrated differences in standing and sitting spinopelvic alignment for all global and regional parameters except PI. When examining the postural changes from standing to sitting, there was less hip ROM in SOA than LOA (71.45 ± 18.55 vs 81.64 ± 12.57, p<0.001). As a result, SOA patients had more change in PT (15.24 ± 16.32 vs 7.28 ± 10.19, p<0.001), PI-LL (20.62 ± 17.25 vs 13.74 ± 11.16, p<0.001), LL (−21.37 ± 15.55 vs −13.09 ± 12.34, p<0.001), and T10-L2 (−4.94 ± 7.45 vs −1.08 ± 5.19, p<0.001) to compensate. SOA had a greater improvement in TPA (15.06 vs 9.59, p<0.001), and less change in PFSA (86.65 vs 88.81, p<0.001) compared to LOA. Conclusions. Spinopelvic compensatory mechanisms are adapted for reduced joint mobility associated with hip OA in standing and sitting

The goal of this study was to develop and validate a short, evaluative self-report questionnaire for the clinical self-assessment of patients with hip osteoarthritis (OA). If used together with other self-report outcome tools (e.g. generic or physical activity measures), such a short joint-specific questionnaire could avoid an increased burden to the patients and decrease the risk of data loss. All items of the new score (Schulthess Hip Score, SHS) were generated solely on patient perceptions, for item removal we used the clinical severity-importance rating and inter-item correlation methods. The final score consisted of only five items. We then assessed the following metric properties of the SHS in 105 consecutive patients with symptomatic hip OA (mean age, 63.4 ± 11 years, 48 women) undergoing total hip arthroplasty (THA) in our clinic: proportion of evaluable questionnaires, reproducibility, internal consistency, concurrent validity, and responsiveness. 97% of the questionnaires were evaluable. Reproducibility of the SHS was excellent (intraclass correlation coefficient (ICC) 0.90; standard error of the measure (SEM) 6.4). Exploratory factor analysis indicated that all items loaded on only 1 factor which accounted for 69.4% of the total variance. Cronbach’s alpha was 0.88. Evidence of convergent validity was provided by moderate to high correlations with scores and subscales of the WOMAC (r = 0.58–0.78), Oxford Hip Score (r = 0.78), Harris Hip Score (r = 0.37), SF-12 physical component scale (r = 0.57), UCLA activity scale (r = 0.48), and Tegner score (r = 0.53). Evidence of divergent validity was provided by a lower correlation with the SF-12 mental component scale (r = 0.37). The SHS proved to be responsive with an effect size (ES) of 2.15 and a standard response mean (SRM) of 1.74 six months after THA. Taken together, the results of this study provide evidence to support the use of the five-item self-report SHS in patients with hip osteoarthritis. Considering the brevity of this score, it could be easily used together with other measures such as generic and physical activity assessment tools, without overburdening patients with an inordinate number of items and questions

In pre-operative planning for total hip arthroplasty (THA), femoral offset (FO) is frequently underestimated on AP pelvis radiographs as a result of inaccurate patient positioning, imprecise magnification, and radiographic beam divergence. The aim of the present study was to evaluate the reliability and accuracy of predicting three-dimensional (3-D) FO as measured on computed tomography (CT) from measurements performed on standardised AP pelvis radiographs. In a retrospective cohort study, pre-operative AP pelvis radiographs and corresponding CT scans of a consecutive series of 345 patients (345 hips, 146 males, 199 females, mean age 60 (range: 40-79) years, mean body-mass-index 27 (range: 29-57) kg/m2) with primary end-stage hip osteoarthritis were reviewed. Patients were positioned according to a standardised protocol and all images were calibrated. Using validated custom programmes, FO was measured on corresponding AP pelvis radiographs and CT scans. Inter- and intra-observer reliability of the measurement methods were evaluated using intra-class correlation coefficients (ICC). To predict 3-D FO from AP pelvis measurements, the entire cohort was randomly split in two groups and gender specific linear regression equations were derived from a subgroup of 250 patients (group A). The accuracy of the derived prediction equations was subsequently assessed in a second subgroup of 100 patients (group B). In the entire cohort, mean FO was 39.2mm (95%CI: 38.5-40.0mm) on AP pelvis radiographs and 44.6mm (95%CI: 44.0-45.2mm) on CT scans. FO was underestimated by 14% on AP pelvis radiographs compared to CT (5.4mm, 95%CI: 4.8-6.0mm, p<0.001) and both parameters demonstrated a linear correlation (r=0.642, p<0.001). In group B, we observed no significant difference between gender specific predicted FO (males: 48.0mm, 95%CI: 47.1-48.8mm; females: 42.0mm, 95%CI: 41.1-42.8mm) and FO as measured on CT (males: 47.7mm, 95%CI: 46.1-49.4mm, p=0.689; females: 41.6mm, 95%CI: 40.3-43.0mm, p=0.607). The results of the present study suggest that femoral offset can be accurately and reliably predicted from AP pelvis radiographs in patients with primary end-stage hip osteoarthritis. Our findings support the surgeon in pre-operative templating and may improve offset and limb length restoration in THA without the routine performance of CT

Coxarthrosis is a common problem. Changes in all articular structures during coxarthrosis were described extensively, besides labrum. This study was designed to:. describe histological changes in the labrum during coxarthrosis, and correlate them with radiographic changes. compare changes in various portions of the labrum. assess labrum status in main etiological types of coxarthrosis. Methods: Consecutive patients scheduled for THR were analyzed. Cases of systemic disorders, septic arthritis of the hip, previous hip surgeries were excluded. All hips were assessed radiographically, and staged according to Hip Osteoarthrosis Radiographic Grading System (HORGS) and for etiology to: dysplastic, idiopathic and avascular necrosis (AVN) groups. From the group of 90 patients in 77 hips we were able to harvest hip labrum during THR. All labra were examined by histological techniques for the presence of: labral matrix degeneration of, granular matrix breakdown, pseudocysts formation, matrix calcifications, chondrocyte apoptosis, macrophage and lymphocyte infiltration, vascular ephiteliar cell and blood vessel formation. After analysis labral histological degeneration score (LHDS) (0–11 points) was designed and computed. Results: Degeneration of the labral matrix was found in all specimens, granular matrix breakdown in 98%, pseudocysts in 91%, calcifications in 22 %, apoptosis in 19%, macrophage infiltration in 30%, lymphocyte infiltration in 19 %, vascular ephiteliar cell in 39 % and blood vessel formation in 35 % of specimens. Average LHDS for all cases was 5.4, and was the highest (6.1) in dysplastic coxarthrosis, followed by idiopathic changes (LHDS 5.7). Significantly lower (p=0.02) values were found in AVN group (LDHS 3.7). In 35 randomly selected patients anterior, middle and posterior portion of labrum was evaluated separately. The highest LDHS was found in middle portion 5.9, comparing to anterior (LDHS 3.5) and posterior (LDHS 4.25) portion, and this difference was significant (p=0.002). Radiographic assessment showed that 10 % of patients had grade 1 changes according to HORGS, 28 % grade 2, and 62% grade 3 changes. Strong correlation (p=0.0002) was found between LDHS and radiographic HORGS scores. Labra of the patients with severe coxathrosis showed more degeneration changes. Conclusions: Hip labrum shows various degenerative changes in the course of coxarthrosis like other structures in the joint. Degree of histological degeneration correlates well with radiographic changes. Small labral changes were found in AVN group with no destruction of acetabulum, the highest labral degeneration was found in cases of dysplastic coxarthrosis. The biggest changes were noted in the middle portion of the labrum. The results of this study proved that degeneration of the labrum is simultaneous with other articular structures and labral degeneration itself promotes coxarthrosis

Aim. This study aimed to assess whether the severity of symptoms (assessed with the Oxford Hip Score (OHS)) can relate to the levels of mRNA expression of markers for muscle inflammation (tumour necrosis factor alpha (TNFα), interleukin 6 (IL-6)) in the proximal vastus lateralis (VL) of patients with severe OA undergoing THR. Methods. Following local research ethics approval and informed consent, 17 patients were prospectively recruited. Muscle biopsies were obtained from the proximal VL (accessed through the surgical wound) intraoperatively whilst the OHS questionnaire was administered preoperatively. mRNA expression for TNFα and IL-6 was assessed using the reverse transcriptase polymerase chain reaction (RT-PCR). The median OHS was used for stratification, with patients above the median classed as having moderate symptoms (MS) and those below classed as having severe symptoms (SS). The effect of SS on muscle inflammation was assessed with relative quotient (RQ) comparison of SS vs. MS mRNA expression. Results. Patients recruited were (mean (SD)) 65.3(8.8) years old in men (n=9) and 59.8 (13.3) years old in women (n=9). The median OHS was 24 (range 10–32) with SS < 24 (n=10) and MS ≥ 24 (n=7). In comparison to the MS group, the SS group had increased TNFα expression (+28% (RQ=1.28, p=0.35)) with reduced IL-6 expression (−44% (RQ=0.56, p=0.35), though neither of these reached statistical significance. Conclusions. Muscle inflammation is not clearly correlated to symptoms in this group. Preoperative subjective functional deficit appears independent of muscle inflammation in patients with hip osteoarthritis

Introduction: The purposes of this study are to investigate the inter-relationship between Stulberg class and radiographic hip osteoarthritis (OA) in patients with Legg-Calvé-Perthes disease (LCP) and to determine whether LCP patients develop hip OA more often than sex- and age-matched individuals. Material and Methods: 167 LCP patients presented to our institution from 1941 to 1962. All patients were treated conservatively by a Thomas splint. Retrospectively medical records and radiographs were retrieved. At follow-up weight-bearing AP pelvis radiographs were obtained. OA was present when the minimum joint space width was < 2.0 mm. Radiographs of sex- and age-matched controls were obtained from The Copenhagen City Heart Study. The following criteria for exclusion were applied:. insufficient or missing radiographs. patients who refused to participate,. emigrated persons,. persons lost to follow-up,. patients with previous surgery to pelvis or lower limbs and. dead persons. 52 patients (55 hips) were enrolled in the study and 115 patients (136 hips) were excluded. Mean age for men at follow-up was 53 years and for women 55 years. Results: In the LCP group four hips of 50 hips had OA compared to one hip of 107 hips in the control group. One patient out of 41 in Stulberg class I/II had OA compared to three out of nine in Stulberg class III/IV/V. Conclusion: LCP patients have a significant higher risk of having hip OA compared to a sex- and age-matched control group, p=0.04 [OR=8.5 (CI=0.8–428.8)]. Patients in Stulberg class III, IV or V have a significantly increases risk of hip OA compared to patients in Stulberg class I or II, p=0.03 [OR=13.7 (CI 1.9–97.1)]

Introduction. The advance of surgical technique and implant design have led to improvement in total hip arthroplasty (THA), and short stem THA is now gaining number as a treatment option for younger patients to preserve bone in the proximal femur for a future revision. The SMF stem is shorter stem, and requires a slightly higher neck resection and implanted in slight varus to contact at lateral cortex. Developmental dysplasia of the hip (DDH) is the most common cause to hip osteoarthritis (OA) in Japan, and the morphology of the dysplastic femur is narrow canal and increased anteversion. Thus, the purpose of this study is to evaluate the SMF stem design can fit for Japanese patients, using CT based 3-D template planning. Methods. We evaluated 30 patients who required THA in our institution. Inclusion criteria are hip OA, but cases with post-trauma, post-osteotomy, and any other hip disease in childhood are excluded. Patients were selected with their femoral anteversion, based on the dispersion of anteversion in dysplastic hip population, which was reported by Noble and collegues in 2003. Preoperative planning with ZedHip software (Lexi, Japan) was performed by established protocol. The center of socket was placed at 15mm proximal from teardrop and medialized to primary acetabulum, with 40° of radiographic inclination and 20° of anteversion. Neck resection of femur was 20mm proximal from the top of smaller trochanter, and stem was placed with lateral fit at distal and medial fit at calcar with appropriate size. Stem offset was selected by leg extension and balanced shenton line. Finally, ROM simulation was performed and the socket anteversion was arranged to achieve the optimal ROM. And then, SMF stem alignment and appropriate fitting was evaluated in Japanese OA cases. Results. Within 30 cases, 28 were female and 2 were male. Mean age was 66.0±9.6, and 8 (26.7%) were primary OA and 22 (73.3%) were secondary OA, from dysplastic hip. SMF stem was placed at average 2.7° varus and 7.2° flexion against femoral axis [Fig. 1]. The average degree of femoral anteversion was 34.0°±10.9 at pre-implantation and 22.7°±9.9 after implantation, which means average 11.4° retroverted [Fig. 2]. Stem offset and neck length variation was acceptable in 28/30 cases (93.3%). Finally, the mean flexion was 130°±7.1 and abduction was 56.0°±5.5, and optimal ROM was achieved 19/30 cases (63.3%). We cannot find any correlation between femoral anteversion pre-implantion and ROM post-implantation, however positive correlation was found between flexion angle and offset length after implantation (r2=0.48). Conclusion. The stem design of SMF is unique to preserve bone stock, but impossible to control anteversion after implantation, so it should be evaluated if it could fit to dysplastic hip. In this 3-D simulation study, SMF stem can be appropriately fitted in most of Japanese cases. Neck length and offset is important to achieve optimal ROM. Large diameter head (≥32mm) and high-offset stem would be suggested, and it may spread the indication for most of the cases regardless of the anteversion of femur. To view tables/figures, please contact authors directly

Introduction. Hip Osteoarthritis (HOA) is a highly heterogeneous disease with potentially different genetic aetiologies. Thus far, few genetic variants have been robustly associated with broad definitions of HOA. We aimed to identify novel HOA susceptibility variants by examining a set of more homogeneous, radiographically-derived endophenotypes relating to anatomic pattern of joint involvement and bone remodelling response in HOA. Materials, Methods and Results. Individuals with HOA and AP-hip radiographs (n=2,109) were selected from the arcOGEN study, genotyped on 2 platforms. The most arthritic hip per patient was categorised using Bombelli's classification (atrophic/normotrophic/hypertrophic), and for pattern of joint space narrowing (superior/medial-axial/concentric). Following 1000-Genomes-Project-based imputation and stringent quality control over 7 million variants were tested for association with each phenotype under the additive model. Fixed-effects meta-analysis was used to combine the results from the two GWA studies. In the discovery GWAS of atrophic HOA vs cases with non-atrophic HOA a strong signal (rs16869403, OR[95% CI]=2.47[1.81–3.38], p=1.53×10. −8. ) was detected in the G protein-coupled receptor, GPR98. Polymorphisms in GPR98 have been associated with osteoporotic fracture and low bone mineral density and GPR98 knockout mice have a low bone mass phenotype. The meta-analysis of medial joint space narrowing showed strong association with variants in LRCH1 (rs754106, OR[95% CI]=1.46[1.26–1.68], P=2.85×10. −7. ) previously associated with OA but with conflicting replication evidence, and BMP1 (chr8:22065846, OR[95% CI]=3.36[2.12–5.33], P=2.6×10. −7. ) which induces bone and cartilage development. None of these variants showed significant evidence for association when broadly classified HOA cases were compared to population-based controls from the arcOGEN GWAS. Conclusion. Through comprehensive examination of radiographically-derived, HOA-related phenotypes we have identified several promising signals that point to novel biologically plausible genes for HOA. Our results indicate that, in a heterogeneous disease like OA the study of narrower phenotype definitions closer to the biology of the disease has the potential to enhance power to detect OA-relevant associations

Aims. The preventive effects of bisphosphonates on articular cartilage in non-arthritic joints are unclear. This study aimed to investigate the effects of oral bisphosphonates on the rate of joint space narrowing in the non-arthritic hip. Methods. We retrospectively reviewed standing whole-leg radiographs from patients who underwent knee arthroplasties from 2012 to 2020 at our institute. Patients with previous hip surgery, Kellgren–Lawrence grade ≥ II hip osteoarthritis, hip dysplasia, or rheumatoid arthritis were excluded. The rate of hip joint space narrowing was measured in 398 patients (796 hips), and the effects of the use of bisphosphonates were examined using the multivariate regression model and the propensity score matching (1:2) model. Results. A total of 45 of 398 (11.3%) eligible patients were taking an oral bisphosphonate at the time of knee surgery, with a mean age of 75.8 years (SD 6.2) in bisphosphonate users and 75.7 years (SD 6.8) in non-users. The mean joint space narrowing rate was 0.04 mm/year (SD 0.11) in bisphosphonate users and 0.12 mm/year (SD 0.25) in non-users (p < 0.001). In the multivariate model, age (standardized coefficient = 0.0867, p = 0.016) and the use of a bisphosphonate (standardized coefficient = −0.182, p < 0.001) were associated with the joint space narrowing rate. After successfully matching 43 bisphosphonate users and 86 non-users, the joint narrowing rate was smaller in bisphosphonate users (p < 0.001). Conclusion. The use of bisphosphonates is associated with decreased joint degeneration in non-arthritic hips after knee arthroplasty. Bisphosphonates slow joint degeneration, thus maintaining the thickness of joint cartilage in the normal joint or during the early phase of osteoarthritis. Cite this article: Bone Joint Res 2022;11(11):826–834

Purpose. Femoroacetabular impingement (FAI) may contribute to the development of early onset hip osteoarthritis (OA). A cam lesion (or pistol grip deformity) of the proximal femur reduces head-neck offset resulting in cam type FAI. The alpha angle is a radiographic measurement recommended for diagnosis of cam type FAI. The purpose of this study was to determine if patients that develop end stage hip OA prior to 55 years of age have radiographic evidence of cam type FAI. Method. The anteroposterior (AP) pelvis and lateral hip radiographs of 244 patients (261 hips) who presented to our institution for hip arthroplasty or hip fracture fixation between 2006 and 2008 were retrospectively reviewed. Three cohorts were compared: 1) patients with end stage hip OA < 55 years old (N=76); 2) patients with end stage hip OA > 55 years old (N=84); 3) hip fracture patients > 65 years old without radiographic evidence of hip arthritis were used as controls (N=101). Patients with inflammatory arthritis, avascular necrosis and post-traumatic hip OA were excluded. Alpha angles were measured on the AP pelvis and lateral radiographs by three coauthors using ImageJ 1.43 software (National Institutes of Health, USA). For patients with end stage hip OA, AP alpha angles were measured on both the hip with OA and the contralateral hip. Lateral alpha angles were measured only on the hip with OA. For patients with hip fracture, AP alpha angles were measured on the non-fractured hip and lateral alpha angles were measured on the fractured hip. A one-way ANOVA with post hoc Tukeys HSD test was used to compare the AP and lateral alpha angles for the three cohorts. Results. The intraclass correlation coefficient (ICC) for the three coauthors measuring AP and lateral alpha angles was 0.85 and 0.86 respectively, indicating excellent inter-rater agreement. Patients < 55 years old with end stage hip OA had the largest AP and lateral alpha angles (82.711.6 degrees AP and 63.918.5 degrees lateral). These angles were significantly larger (p<0.01 for both comparisons) than patients > 55 years old with end stage hip OA (71.717.8 degrees AP and 55.518.0 degrees lateral) and hip fracture patients without hip OA (52.710.9 degrees AP and 44.411.4 degrees lateral). Comparing AP alpha angles of the contralateral hips, the mean AP alpha angle for patients < 55 years old with hip OA (70.813.2 degrees) was significantly larger (p=0.04) than patients > 55 years old with hip OA (64.516.2 degrees) which in turn was significantly larger (p<0.01) than the hip fracture patients (52.710.9 degrees). Conclusion. Patients < 55 years old with hip OA had the largest mean AP and lateral alpha angles, significantly larger than patients > 55 years old with hip OA and hip fracture patients without hip OA. Thus young patients with end stage hip OA do have radiographic evidence of cam type FAI. Furthermore, this case-controlled study suggests that cam type FAI may contribute to the development of early onset hip OA

Background: Patients suffering from hip osteoarthritis (OA) are frequently symptomatic, and the disease can result in significant limitation of patients’ activity and high social costs. Viscosupplementation, which aims to restore physiological and rheological features of the synovial fluid, is a well-accepted therapeutic option in knee OA patients, but limited data exist in the literature about its potential benefit for the treatment of hip OA. Aim: To evaluate the efficacy and safety of viscosupplementation (VS) with hyaluronic acid (Hylan GF 20) under fluoroscopic guidance in patients with symptomatic hip OA. Methods: Forty six patients (26 men, 20 women, mean age 56.4 years) with symptomatic hip OA were treated with one injection of 2 ml of hylan G-F 20(Synvisc) under fluoroscopic guidance which could be repeated after at least 3 months. Treatment efficacy was assessed by functional index oxford hip score, pain evaluation on a visual analogue scale and NSAID consumption. All such parameters were recorded at baseline as well as 2, 6 and 12 months after the beginning of the treatment. Results: We observed a statistically significant reduction of all considered parameters at the timepoints 2 and 6 months, when compared to baseline. At 12 months the changes were still statistically significant for all parameters for about 50% of the patients. Three patients reported self-limited mild, local pain post-injection otherwise no systemic adverse events were observed. Conclusion: Viscosupplementation with hylan G-F20 is feasible, easy to perform as well as safely relieves osteoarthritis hip pain, facilitates an improved activity level, decreases the need for pain medication, physiotherapy, and assistive devices